Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

doi:10.1016/j.jmii.2020.03.011

. 2020 Jun;53(3):377-380.

doi: 10.1016/j.jmii.2020.03.011. Epub 2020 Mar 14.

Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

Muh-Yong Yen¹, Jonathan Schwartz², Shey-Ying Chen³, Chwan-Chuen King⁴, Guang-Yang Yang⁵, Po-Ren Hsueh⁶

Affiliations

¹ Division of Infectious Diseases, Taipei City Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: myyen1121@gmail.com.
² Department of Political Science, State University of New York, New Paltz, NY, USA.
³ Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan.
⁵ Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, 11221 Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 32205090
PMCID: PMC7156133
DOI: 10.1016/j.jmii.2020.03.011

Free PMC article

Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

Muh-Yong Yen et al. J Microbiol Immunol Infect. 2020 Jun.

Free PMC article

. 2020 Jun;53(3):377-380.

doi: 10.1016/j.jmii.2020.03.011. Epub 2020 Mar 14.

Authors

Muh-Yong Yen¹, Jonathan Schwartz², Shey-Ying Chen³, Chwan-Chuen King⁴, Guang-Yang Yang⁵, Po-Ren Hsueh⁶

Affiliations

¹ Division of Infectious Diseases, Taipei City Hospital, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: myyen1121@gmail.com.
² Department of Political Science, State University of New York, New Paltz, NY, USA.
³ Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan.
⁵ Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, 11221 Taiwan.
⁶ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

PMID: 32205090
PMCID: PMC7156133
DOI: 10.1016/j.jmii.2020.03.011

Abstract

We argue that enhanced Traffic Control Bundling (eTCB) can interrupt the community-hospital-community transmission cycle, thereby limiting COVID-19's impact. Enhanced TCB is an expansion of the traditional TCB that proved highly effective during Taiwan's 2003 SARS outbreak. TCB's success derived from ensuring that Health Care Workers (HCWs) and patients were protected from fomite, contact and droplet transmission within hospitals. Although TCB proved successful during SARS, achieving a similar level of success with the COVID-19 outbreak requires adapting TCB to the unique manifestations of this new disease. These manifestations include asymptomatic infection, a hyper-affinity to ACE2 receptors resulting in high transmissibility, false negatives, and an incubation period of up to 22 days. Enhanced TCB incorporates the necessary adaptations. In particular, eTCB includes expanding the TCB transition zone to incorporate a new sector - the quarantine ward. This ward houses patients exhibiting atypical manifestations or awaiting definitive diagnosis. A second adaptation involves enhancing the checkpoint hand disinfection and gowning up with Personal Protective Equipment deployed in traditional TCB. Under eTCB, checkpoint hand disinfection and donning of face masks are now required of all visitors who seek to enter hospitals. These enhancements ensure that transmissions by droplets, fomites and contact are disrupted both within hospitals and between hospitals and the broader community. Evidencing eTCB effectiveness is Taiwan's success to date in containing and controlling the community-hospital-community transmission cycle.

Keywords: COVID-19; Community-hospital-community transmission; Fomite transmission; SARS-CoV; Traffic control bundling; eTCB.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest We declare no competing interests.

Figures

**Figure 1**
Proposed mechanism of community-hospital-community chain of amplification in COVID-19.

**Figure 2**
Enhanced traffic control bundling.

See this image and copyright information in PMC

Cited by

To PCR or not? The impact of shifting policy from PCR to rapid antigen tests to diagnose COVID-19 during the omicron epidemic: a nationwide surveillance study.
Chi H, Chiu NC, Chen CC, Weng SL, Lien CH, Lin CH, Hu YF, Lei WT, Tai YL, Lin LY, Liu LY, Lin CY. Chi H, et al. Front Public Health. 2023 Jul 20;11:1148637. doi: 10.3389/fpubh.2023.1148637. eCollection 2023. Front Public Health. 2023. PMID: 37546311 Free PMC article.
Preventing and controlling intra-hospital spread of COVID-19 in Taiwan - Looking back and moving forward.
Lin KY, Pan SC, Wang JT, Fang CT, Liao CH, Cheng CY, Tseng SH, Yang CH, Chen YC, Chang SC. Lin KY, et al. J Formos Med Assoc. 2024 Jan;123 Suppl 1:S27-S38. doi: 10.1016/j.jfma.2023.05.018. Epub 2023 May 22. J Formos Med Assoc. 2024. PMID: 37268473 Free PMC article. Review.
How Taiwan has responded to COVID-19 and how COVID-19 has affected Taiwan, 2020-2022.
Lai CC, Lee PI, Hsueh PR. Lai CC, et al. J Microbiol Immunol Infect. 2023 Jun;56(3):433-441. doi: 10.1016/j.jmii.2023.04.001. Epub 2023 Apr 6. J Microbiol Immunol Infect. 2023. PMID: 37061349 Free PMC article. Review.
Impact of SARS-CoV-2/COVID-19 on Provision of Medical Care to Patients With Systemic Autoimmune Rheumatic Disease and the Practice of Rheumatology.
Bankole AA, Nwaonu J, Saeed J. Bankole AA, et al. Cureus. 2023 Feb 24;15(2):e35402. doi: 10.7759/cureus.35402. eCollection 2023 Feb. Cureus. 2023. PMID: 36987476 Free PMC article. Review.
Impact of Plastic-Wrap Properties and Cleaning Intervals on the Disinfection of Elevator Buttons.
Kuo SH, Liu TY, Chen TC, Yang CJ, Chen YH. Kuo SH, et al. Int J Environ Res Public Health. 2023 Jan 16;20(2):1649. doi: 10.3390/ijerph20021649. Int J Environ Res Public Health. 2023. PMID: 36674403 Free PMC article.

See all "Cited by" articles

References

1. Morens D.M., Daszak P., Taubenberger J.K. Escaping Pandora's Box — another novel coronavirus. N Engl J Med. 2020 February 26 doi: 10.1056/NEJMp2002106. - DOI - PubMed
1. Ong S.W.X., Tan Y.K., Chia P.Y., Lee T.H., Ng O.T., Wong M.S.Y. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. J Am Med Assoc. 2020 Mar 4 doi: 10.1001/jama.2020.3227. - DOI - PMC - PubMed
1. Yen M.Y., Lin Y.E., Lee C.H., Ho M.S., Huang F.Y., Chang S.C. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among health care workers. J Hosp Infect. 2011;77:332–337. - PMC - PubMed
1. Yen M.Y., Chiu A.W.-H., Schwartz J., King C.C., Lin Y.E., Chang S.C. From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic. J Hosp Infect. 2014;87:185–193. - PMC - PubMed
1. Yen M.Y., Schwartz J., Chiu A.W.H., Armstrong D., Hsueh P.R. Traffic control bundling is essential for protecting healthcare workers and controlling the ebola epidemic 2014. Clin Infect Dis. 2015;60:823–825. - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

[1] Morens D.M., Daszak P., Taubenberger J.K. Escaping Pandora's Box — another novel coronavirus. N Engl J Med. 2020 February 26 doi: 10.1056/NEJMp2002106. - DOI - PubMed

[2] Morens D.M., Daszak P., Taubenberger J.K. Escaping Pandora's Box — another novel coronavirus. N Engl J Med. 2020 February 26 doi: 10.1056/NEJMp2002106. - DOI - PubMed

[3] Ong S.W.X., Tan Y.K., Chia P.Y., Lee T.H., Ng O.T., Wong M.S.Y. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. J Am Med Assoc. 2020 Mar 4 doi: 10.1001/jama.2020.3227. - DOI - PMC - PubMed

[4] Ong S.W.X., Tan Y.K., Chia P.Y., Lee T.H., Ng O.T., Wong M.S.Y. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. J Am Med Assoc. 2020 Mar 4 doi: 10.1001/jama.2020.3227. - DOI - PMC - PubMed

[5] Yen M.Y., Lin Y.E., Lee C.H., Ho M.S., Huang F.Y., Chang S.C. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among health care workers. J Hosp Infect. 2011;77:332–337. - PMC - PubMed

[6] Yen M.Y., Lin Y.E., Lee C.H., Ho M.S., Huang F.Y., Chang S.C. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among health care workers. J Hosp Infect. 2011;77:332–337. - PMC - PubMed

[7] Yen M.Y., Chiu A.W.-H., Schwartz J., King C.C., Lin Y.E., Chang S.C. From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic. J Hosp Infect. 2014;87:185–193. - PMC - PubMed

[8] Yen M.Y., Chiu A.W.-H., Schwartz J., King C.C., Lin Y.E., Chang S.C. From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic. J Hosp Infect. 2014;87:185–193. - PMC - PubMed

[9] Yen M.Y., Schwartz J., Chiu A.W.H., Armstrong D., Hsueh P.R. Traffic control bundling is essential for protecting healthcare workers and controlling the ebola epidemic 2014. Clin Infect Dis. 2015;60:823–825. - PMC - PubMed

[10] Yen M.Y., Schwartz J., Chiu A.W.H., Armstrong D., Hsueh P.R. Traffic control bundling is essential for protecting healthcare workers and controlling the ebola epidemic 2014. Clin Infect Dis. 2015;60:823–825. - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

Affiliations

Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Miscellaneous

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Miscellaneous